STEPHEN NOYES has heard a new worry from his patients and parishioners. Both a therapist and the local deacon, he is counselling an increasing number who fear they will lose their health care. Mr Noyes is a social worker at an Ammonoosuc Community Health Services clinic in rural New Hampshire where people trundle over three mountain passes for a session. A fifth of patients at Ammonoosuc receive treatment at least partly thanks to Medicaid, which provides health cover for the poor or disabled. It is not only patients who are concerned. “I don’t know what we’d do without Medicaid,” says Nicole Fischler, a nurse and manager at the clinic. “When you cut that, you cut a lifeline.” It is not a phantom pain: an obscure state law could lead New Hampshire to chuck a third of enrollees off Medicaid within six months of a federal budget passing.